Prophylactic administration of parenteral steroids for preventing airway complications after extubation in adults: meta-analysis of randomised placebo controlled trials.
OBJECTIVE
To determine whether steroids are effective in preventing laryngeal oedema after extubation and reducing the need for subsequent reintubation in critically ill adults.


METHODS
Meta-analysis.


METHODS
PubMed, Cochrane Controlled Trials Register, Web of Science, and Embase with no limitation on language, study year, or publication status. Selection criteria Randomised placebo controlled trials in which parenteral steroids were compared with placebo for preventing complications after extubation in adults. Review methods Search, application of inclusion and exclusion criteria, data extraction, and assessment of methodological quality, independently performed in duplicate. Odds ratios with 95% confidence intervals, risk difference, and number needed to treat were calculated and pooled.


METHODS



METHODS
laryngeal oedema after extubation. Secondary outcome: subsequent reintubation because of laryngeal oedema.


RESULTS
Six trials (n=1923) were identified. Compared with placebo, steroids given before planned extubation decreased the odds ratio for laryngeal oedema (0.38, 95% confidence interval 0.17 to 0.85) and subsequent reintubation (0.29, 0.15 to 0.58), corresponding with a risk difference of -0.10 (-0.12 to -0.07; number needed to treat 10) and -0.02 (-0.04 to -0.01; 50), respectively. Subgroup analyses indicated that a multidose regimen of steroids had marked positive effects on the occurrence of laryngeal oedema (0.14; 0.08 to 0.23) and on the rate of subsequent reintubation (0.19; 0.07 to 0.50), with a risk difference of -0.19 (-0.24 to -0.15; 5) and -0.04 (-0.07 to -0.02; 25). In single doses there was only a trend towards benefit, with the confidence interval including 1. Side effects related to steroids were not found.


CONCLUSIONS
Prophylactic administration of steroids in multidose regimens before planned extubation reduces the incidence of laryngeal oedema after extubation and the consequent reintubation rate in adults, with few adverse events.
Fan
Tao
T
Pneumology Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China.
Wang
Gang
G
Mao
Bing
B
Xiong
Zeyu
Z
Zhang
Yu
Y
Liu
Xuemei
X
Wang
Lei
L
Yang
Sai
S
D016638:Critical Illness / Q000628:therapy*; D020878:Device Removal / Q000009:adverse effects; D006801:Humans; D007263:Infusions, Parenteral; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D007819:Laryngeal Edema / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial / Q000009:adverse effects; D019233:Retreatment; D013256:Steroids / Q000008:administration & dosage*; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000009:adverse effects
D013256:Steroids